Empowerment-based Interventions Research Articles

The Role of Alternative Medicine in Managing Type 2 Diabetes: A Comprehensive Review.

Diabetes, a chronic metabolic disorder marked by elevated blood glucose levels, is increasingly prevalent globally, significantly impacting health-related quality of life. Type 2 diabetes (T2DM), characterized by insulin resistance and inadequate insulin production, presents a substantial public health challenge, necessitating comprehensive management strategies. Conventional treatments, including lifestyle modifications and pharmacotherapy, are essential for glycemic control and preventing complications. However, adherence to these treatments is often limited, highlighting the need for alternative strategies. Complementary and alternative medicine (CAM) offers potential cost-effective and accessible approaches for managing T2DM.Key herbal remedies like cinnamon, fenugreek, and bitter melon, along with dietary supplements like chromium, magnesium, and vanadium, have shown promise in glycemic control. Mind-body therapies, including yoga, tai chi, and meditation, contribute to improved hemoglobin A1c and fasting blood glucose levels. Research supports the integration of CAM with conventional therapies, demonstrating enhanced clinical efficacy and reduced economic burden. However, challenges such as standardization, quality control, and potential risks of herbal medicines need careful consideration. Regulatory frameworks and ethical considerations are essential to ensure patient safety and informed decision-making.Patient education and effective communication between healthcare providers and patients are crucial for integrating CAM into diabetes management. Empowerment-based interventions and collaborative approaches can enhance self-management skills and clinical outcomes. Overall, integrating CAM with conventional treatments offers a holistic approach to managing T2DM, potentially improving patient outcomes and reducing healthcare costs.

A Systematic Review of Experimental Studies on the Impact of Empowerment-Based Interventions on Child and Parent Outcomes in the Pediatric Oncology Setting.

Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary caretakers, parents are frequently unprepared or engage in inappropriate behavior when caring for their children. Increasing parents' role through empowerment is critical in pediatric cancer care. This systematic review aimed to identify the effect of empowerment interventions on parent and child outcomes in pediatric oncology. In this review, studies published between 2013 and 2023 in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Medline, and Scopus databases were identified using a search strategy to identify relevant studies that determined empowerment-based intervention for parents in the pediatric oncology. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies. This systematic review followed the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards. Seven studies met the inclusion criteria: four randomized and three non-randomized experimental studies. Children range in age from 1-14 years. The intervention is mostly delivered through face-to-face learning using booklets or modules as a learning tool. The intervention is delivered in 2-6 sessions over 1-8 weeks, lasting 20-45 minutes each. In most studies, the interventions positively affect parents' outcomes (knowledge, caring behavior, distress, care burden, quality of life) and children's outcomes (oral mucositis, gastrointestinal complications, quality of life). The intervention, however, has no significant effect on the coping style. Barriers to implementation include parent-nurse commitment, the retention of parent-nurse participation, and more time spent to provide interventions. Our study highlights that empowerment-based interventions positively impact parents and children. These findings suggest that an empowerment-based intervention should be developed to provide better cancer care for a parent and their children. PROSPERO registration number was CRD42023422834.

Fostering Psychological Empowerment in Women: Exploring Transformative Group Dynamics and Empowerment-Based Interventions in Girl Up Ikhtiyar

Despite making substantial strides, contemporary societies across the globe continue to suffer from gender disparity and inequality. These issues have a significant impact on the lives of women, both in the public and private domains. To bring about sustainable change in attitudes towards women and non-binary genders, innovative solutions and transformative leadership are crucial. This research paper delves into the role of transformative group dynamics and empowerment-based interventions in promoting gender equality among women, specifically by studying the work of Girl Up Ikhtiyar (henceforth GUI), a student-led organization that aims to empower girls and young women in India through education, advocacy, and activism. The study’s findings and implications suggest that GUI can fully integrate psychological empowerment and transformative group dynamics into its programs and policies, leading it closer to gender equality.

A Social Return on Investment Evaluation of the Pilot Social Prescribing EmotionMind Dynamic Coaching Programme to Improve Mental Wellbeing and Self-Confidence.

The COVID-19 pandemic contributed to longer waiting lists for people seeking to access mental health services. The NHS Five Year Forward View encourages the development of empowerment-based social prescribing interventions to supplement existing mental health programmes. Based in South Wales, EmotionMind Dynamic (EMD) is a lifestyle coaching programme that supports individuals suffering from anxiety or depression. In this evaluation of lifestyle coaching, a mixed-method social return on investment (SROI) methodology was used to value quantitative and qualitative data from face-to-face and online participants. Data collection took place between June 2021 and January 2022. Participants included both self-referred clients and those referred from health services. Mental wellbeing data were collected at baseline and at the end of the programme using the short Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS) and the General Self-Efficacy Scale (GSES). Baseline and follow-up data were available for 15 face-to-face participants and 17 online clients. Wellbeing valuation quantified and valued outcomes from participants. Results indicated that for every GBP 1 invested, lifestyle coaching generated social values ranging from GBP 4.12–GBP 7.08 for face-to-face clients compared with GBP 2.37–GBP 3.35 for online participants. Overall, lifestyle coaching generated positive social value ratios for both face-to-face and online clients.

A Social Return on Investment evaluation of the Emotion-Mind Dynamic (EMD) two phase social prescribing life coaching intervention to support mental health and wellbeing.

BackgroundThe COVID-19 pandemic has created excess weighting lists to access Mental Health Services in the UK (Stats Wales, 2021). It is important to find effective solutions to alleviate the pressures that Mental Health services experience. The NHS Five Year Forward View encourages the development of new social prescribing empowerment-based interventions to supplement existing mental health programmes (Mental Health Taskforce, 2016). The EmotionMind Dynamic (EMD) is a lifestyle coaching programme that supports individuals suffering from anxiety or depression referred from the health and social care sectors. EMD offers a unique, non-clinical mixed-modality approach combining coaching, mentoring, counselling skills, teaching and mindfulness.
 MethodsSocial Return On Investment (SROI) methodology is applied to evaluate the EMD service. The aim of the SROI analysis is to develop a programme-level theory of change to establish how inputs (e.g. costs, staffing) are converted into outputs (e.g. numbers of clients seen), and subsequently into outcomes that matter to clients impacted by EMD service (e.g. improved mental wellbeing). Wellbeing valuation will quantify and value outcomes using two value sets. The SROI mixed-method approach collects quantitative and qualitative data from questionnaires and interviews with former face-to-face EMD clients as well a new clients, undertaking the online blended learning programme.
 FindingsInitial results indicate that the social prescribing face-to-face EMD programme generated positive social value ratios ranging from £9 to £23 for every £1 invested. In addition, the General Self-Efficacy Scale (GSES) which measures participant’s self-reported self-efficacy and confidence indicated that the face-to-face EMD participants experienced improved mental wellbeing and resilience as a result of participating in the EMD lifestyle coaching programme. Sensitivity analyses was conducted with Social Value Bank (SVB) figures for improved confidence and confirmed assumptions that former EMD clients experienced positive mental wellbeing improvements as a result of undertaking the lifestyle coaching programme.
 ConclusionsThis is the first study to undertake an SROI analysis of a social prescribing lifestyle coaching programme aimed at improving mental wellbeing and resilience. Phase one of this novel SROI study of the face-to-face EMD clients indicates that the EMD lifestyle coaching programme has the potential to generate positive social value ratios. Phase two analysis of the online EMD blended learning programme will compare the effectiveness of the two lifestyle coaching formats: face to face and the online blended format to improve mental wellbeing and self-efficacy by participating in this innovative lifestyle coaching programme.

Creating a Person- and Family-Centered Program of Research: Lessons Learned From Over 30 Years of Applied Research

Approximately 6 million Americans are living with Alzheimer’s Disease or related dementia. Due to these alarming statistics, there is an increased need for families to seek out services and supports to not only cope with these devastating diagnoses, but to plan effectively for their future care needs. A plethora of research has shown that both the family care partner and person living with dementia are at-risk for negative outcomes such as depression, anxiety, social isolation, and worsening physical and mental health. Moreover, further and encouraging research supports the development and implementation of empowerment-based, person- and family-centered interventions. When utilized effectively these interventions improve quality of care and well-being in persons living with dementia and their care partners. The purpose of this paper is to provide guidance for researchers interested in making their work more person- and family-centered. Strategies discussed are based on over 30 years of applied research and include: 1) placing individuals at the center of their own care, 2) including persons with dementia as co-investigators, 3) convening diverse professionals and individuals in advisory councils from the start, and 4) conducting focus groups to obtain participant and stakeholder feedback. Demonstrations of select person-and-family-centered, evidence-programs will be included and supplemented with case examples to illustrate person-centered principles in practice.

Effectiveness of empowerment-based intervention on HbA1c and self-efficacy among cases with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

Objective:The aim of this study was to determine the effect of empowerment-based interventions on glucose metabolism control and psychosocial self-efficacy in people with type 2 diabetes mellitus (T2DM).Methods:The Cochrane Library, Embase, PubMed, and Web of Science electronic databases were searched up to 22 February 2021 for randomized controlled trials (RCTs) that evaluated the effectiveness of empowerment-based intervention versus conventional treatment in type 2 diabetes cases. At least two investigators independently screened the literature, extracted data and evaluated the methodological quality. We calculated the pooled effect size using the mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) through RevMan V 5.4.1.Results:Fifteen randomized controlled trials (RCTs) were eligible for inclusion in the present study. A total of 2344 adults (1128 in the intervention groups and 1216 in the control) were covered. Five of these studies involved 671 cases of psychosocial self-efficacy, and 4 studies included 622 cases of diabetes knowledge. The meta-analysis showed that compared to routine care, empowerment-based intervention was associated with reduced glycated hemoglobin levels (SMD −0.20; 95% CI −0.31 to −0.08; Z = 3.40, P < .001, I2 = 42%), increased diabetes empowerment scores (SMD 0.24; 95% CI 0.10–0.37; Z = 3.42, P < .001, I2 = 0%), and increased diabetes knowledge scores (SMD 0.96; 95% CI 0.55–1.36; Z = 4.61, P < .001, I2 = 80%).Conclusions:Empowerment-based intervention in adults with T2DM results in improvements in glycated hemoglobin, psychosocial self-efficacy and diabetes knowledge.

Effect of Empowerment Program with and without Telenursing on Self-efficacy and Glycosylated Hemoglobin Index of Patients with Type-2 Diabetes: A Randomized Clinical Trial.

Introduction: Developing new training methods for improving the health of diabetic patients has always been a concern for nurses. The present study aims to investigate the effects of empowerment-based interventions with or without telenursing on self-efficacy and HbA1c level in diabetic patients.Methods: In this randomized clinical trial, 156 patients with type-2 diabetes were randomly assigned into two intervention groups (empowerment with/without telenursing) and one control group. All subjects in the intervention groups participated in two sessions of the empowerment program. However, only the group of empowerment with telenursing received telephone counseling for 12 weeks. The patients in the control group did not receive any intervention programs. Self-efficacy was measured by diabetes-specific self-efficacy scale. The HbA1c level was measured using Bionic kit. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, Ill., USA).Results: After 14 weeks, while the changes in self-efficacy scores of the control group were not statistically significant, they were significant in the two intervention groups. Comparison of the two intervention groups showed that self-efficacy was higher in the group of empowerment with telenursing. It was only in the empowerment with telenursing group that the reduction of HbA1 c was significant.Conclusion: Training based on empowerment models and emphasis on the strengths of clients in solving their own problems can play a major role in increasing self-efficacy and reduction of HbA1c level. In addition, a continuous training program, along with telephone follow-ups can result in higher self-efficacy and lower HbA1c level.

Psychosocial empowerment-based interventions for smoking reduction: concepts, measures and outcomes. A systematic review.

Although empowerment is a widely used concept in health-related areas, its definition remains unclear. While there is evidence for the effectiveness of empowerment interventions in improving some psychosocial factors linked to health (e.g. patient self-care strategy, coping skills, access and effective use of health services) and some health outcomes like mental health and HIV/AIDS-related behaviour, other data appear to contradict this. Moreover, concepts, measures, and outcomes related to empowerment are operationalized in different ways. Using the case of tobacco control programmes, we wanted to explore: (a) how research on smoking reduction/prevention has conceptualized empowerment; (b) which measures and instruments have been used to assess behaviour outcomes and the empowerment process. We hypothesized that the transformative potential that characterizes empowerment is marginally considered.A total of 18 studies reporting on the effect of prevention interventions on smoking and/or empowerment outcomes were reviewed. Two kinds of study were distinguished: (a) studies reporting behaviour outcomes without data about the impact on empowerment; (b) studies analysing the empowerment process. Among this latter type, some studies did not provide information about the specific behaviour (smoking), while others examined the impact of intervention on both smoking and empowerment. In about half of all studies, empowerment strategies were found to be effective in improving smoking outcomes, while no differences were found between intervention and control groups in the remaining studies. The present review suggests that pragmatic definitions of empowerment need to be developed in order to promote its transferability and evaluation.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

Empowerment-based interventions in people with multiple sclerosis: a review study

Introdution: Multiple sclerosis is a chronic disease in the nervous system; It has many problems due to its chronic and promising nature. The treatment of this disease includes medical care and empowerment interventions for symptom management. The purpose of this study was to review the empowerment interventions in these patients. Methods: This study was conducted in a Systematic Reviewperiod from January 2000 to June 2018. On indexing sites “Magiran, PubMed, Google Scholar and Science Direct” searched the key words of Multiple Sclerosis, Chronic Disease, Quality of Life, Self-care, Self-management, Rehabilitation, Empowerment, Psychotherapy, Psychological interventions, Clinical Trials, and Randomized Clinical Trial. Out of 1855 articles found, 33 articles were selected for review. Results: The results of this study showed that empowerment interventions in people with MS can be divided into four categories of self-care, self-management, rehabilitation and psychotherapy interventions. Lack of attention to empowerment interventions in people with MS, especially in the Iran, low attention to male patients in implementing interventions, failure to consider the theoretical framework in the formulation of interventions, lack of follow-up test and non-use of virtual intervention methods (Such as using DVDs, consulting and telephone training, etc.) in Iranian studies, is one of the most respected points in previous studies. Conclusion: Empowerment studies have provided significant results in reducing symptoms and improving the quality of life of patients, which can help improve these interventions by considering some of the points.

Empowerment of patients with type 2 diabetes: current perspectives.

Patient empowerment is a continuous process in which knowledge, motivation, and capacity to take control of their disease are built within a person. This concept is not always well understood and applied. This review describes the strategies to induce empowerment in patients with diabetes. In addition, the most common scales used to evaluate empowerment in diabetes is described. Furthermore, the effectiveness of the empowerment-based interventions for improving metabolic control and diabetes knowledge are described. Finally, we discuss opportunities for empowerment implementation in clinical practice and current needs on research that can be translated into public policies.

A systematic Review Study on the Results of Empowerment-Based Interventions in Diabetic Patients

Introduction: Diabetes mellitus is one of the most prevalent diseases caused by metabolic disorders and an important global challenge. Empowerment is a collaborative approach to diabetes care and patient education. In this study, our intention is to systematically review the effects of empowerment interventions in diabetic patients, in order to understand the impact of empowerment on diabetic patients, this study was conducted with the aim of doing this. Materials and Methods: In this systematic review, we used the articles published in the last 30 years regarding the results of empowerment interventions in patients with diabetes. It was conducted in English and Persian by searching articles in search engines, scholarly sites and databases Magiran, Google Scholar, Embase, ResearchGate, Sciencedirect, PubMed, Springer. In the first stage 40 articles were found. Of these, 15 related articles that have been published in the last 30 years have been reviewed. Results: In this study, 15 papers were reviewed the empowerment approach of diabetic patients increases the level of knowledge, Increasing self-efficacy and improving the quality of life of adolescents, Making positive changes in the overall scale of attitude towards the disease and the patient's independent independence scale, Improve self-esteem scores and self-care and reducing the amount of hemoglobin A1C, Improve overall self-care behaviors, Reducing Glycosylated Hemoglobin and Improving Quality of Life, Blood glucose control (decrease in HbA1c), and so on. Conclusion: The review of this review confirms the importance of empowerment-based interventions on increased control and self-care in diabetes patients in diabetic patients. Not paying attention to all dimensions of empowerment, not paying attention to the impact of demographic variables on empowerment, failure to follow up programs Lack of training by specialist staff and so on Can be seen by reviewing the results of the studies. Therefore, considering the broad concept of empowerment and as an effective approach to protecting patients with diabetes, it's necessary these restrictions will be considered in future research.

A structured review of psychiatric rehabilitation for individuals living with severe mental illness within three regions of the Asia-Pacific: Implications for practice and policy.

Psychiatric rehabilitation can provide and support recovery-oriented care by assisting individuals living with severe mental illness to lead full lives. Despite a well-established evidence-base, implementation and access to these interventions in clinical practice for people with severe mental illness in the Asia-Pacific region is low. We therefore aimed to evaluate prominent themes impacting on clinical practice, policy, and the implementation of psychiatric rehabilitation across the Asia-Pacific region. A comprehensive review of relevant literature on psychiatric rehabilitation of three regions within the Asia-Pacific was conducted using a structured search of PubMed and other databases. Eligible articles were selected which focussed on how psychiatric rehabilitation is defined and implemented across the Asia-Pacific region, as well as the associated successes and challenges. Common themes were generated. Six themes emerged: the impact of policy, legislation, and human rights; access difficulties; the important role of family; the significance of culture, religion, and spiritual beliefs; the widespread impact of stigma; and the indigenous models of excellence being developed. Consideration of the six themes and their implications should help raise awareness of the issues involved in the provision of psychiatric rehabilitation in the Asia-Pacific region and may improve outcomes for people living with severe mental illness. Suggested strategies include: developing a shared understanding of psychiatric rehabilitation; establishing quality legislation that's well implemented; adapting evidence-based models to develop culturally appropriate services; implementing stigma reduction and empowerment-based interventions; and, ensuring coordinated action among all stakeholders, combined with effective leadership.

A systematic review and meta-analysis: Effectiveness of internet empowerment-based self-management interventions on adults with metabolic diseases.

To synthesize the effects of Internet empowerment-based self-management interventions on adults with metabolic diseases. Metabolic diseases are prevalent and burden healthcare systems; they have become a major health problem worldwide. The effects of IESMIs on lifestyle changes have been shown to improve adults' physiological and psychological conditions. However, we found no systematic review evaluating these effects. Systematic review and meta-analysis of randomized and non-randomized controlled trials, conducted according to the Cochrane handbook. A literature search was conducted using the Airiti Library, Association for Computing Machinery, CINAHL, Cochrane Library, Embase, ProQuest, PubMed/MEDLINE and Index of the Taiwan Periodical Literature System databases (earliest-June 2016). Two reviewers used the Cochrane Collaboration bias assessment tool to assess the methodological quality of included studies. Extracted data were entered and analysed using RevMan 5.3.5 software. Inverse variance was used to estimate effect sizes. Weighted and standardized mean differences with 95% confidence intervals were calculated using a random effects model. Subgroup and sensitivity analyses were performed. Twenty-one randomized controlled trials were reviewed. Meta-analysis showed that the intervention significantly improved adults' exercise habits, glycated haemoglobin (HbA1c) levels, body weight, empowerment levels and quality of life. The intervention significantly improve the health status of adults with metabolic diseases, in particular their exercise habits, HbA1c levels, body weight, empowerment and quality of life. The intervention provides more convenient and faster access to healthcare for busy individuals with time constraints. These results suggest that healthcare professionals could develop accessible and friendly interactive online interfaces for patients to expand the use of these interventions in the clinical setting.

Effectiveness of a patient-centred, empowerment-based intervention programme among patients with poorly controlled type 2 diabetes: A randomised controlled trial

BackgroundDespite extensive efforts and advances in evidence-based diabetes management, poor glycaemic control still remains a challenge in many countries. There is a paucity of research addressing the needs of patients with poorly controlled type 2 diabetes, or exploring the effectiveness of empowerment-based interventions in this vulnerable population. ObjectivesTo evaluate the effectiveness of a patient-centred, empowerment-based programme on glycaemic control and self-management behaviours among patients with poorly controlled type 2 diabetes. DesignA prospective multi-centre, single-blind, randomised controlled trial. Settings and participantsAdult patients with poorly controlled type 2 diabetes [Haemoglobin A1c (HbA1c) ≥7.5% in the recent six months] were recruited from two tertiary hospitals in Xi’an city, China. MethodsA total of 242 eligible patients were recruited and randomly assigned to the intervention or attentional control groups after baseline measurement. Participants in the intervention group received a 6-week patient-centred, empowerment-based self-management programme, which is theoretically grounded on the principles of the Empowerment Process Model-setting personally meaningful goals, taking action towards goals and reflecting on the impact of action plans. Those in the attentional control group received health education classes and post-discharge follow-up. Outcome measures included glycaemic control (measured by HbA1c) and self-management behaviours. Data were collected at baseline, and at 8th and 20th week after enrolment. Intervention effect were analysed using the generalised estimating equation model on the basis of the intention-to-treat principle. ResultsCompared with the attention control group, the intervention group showed a non-significant HbA1c reduction of 0. 476% (Cohen’s d effect size=0.31, p=0.162). The intervention group exhibited significant improvements in general diet management at the 8th-week (β=0.740; p=0.013), specific diet management at 8th-week (β=0.646; p=0.022) and 20th-week (β=0.517; p=0.043), and blood glucose self-monitoring at both the 8th- (β=0.793; p=0.009) and 20th-week (β=0.739; p=0.017) follow-ups. No intervention-related adverse events were observed. ConclusionsFindings indicate that the patient-centred, empowerment-based self-management intervention program did not induce a significant HbA1c reduction. Whereas this intervention yields improvements in diet management and blood glucose self-monitoring among patients with poorly controlled type 2 diabetes.

Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program

BackgroundSocial marginalization and criminalization create health and safety risks for sex workers and reduce their access to health promotion and prevention services compared to the general population. Community empowerment-based interventions that prioritize the engagement of sex workers show promising results. Peer-to-peer interventions, wherein sex workers act as educators of their colleagues, managers, clients and romantic partners, foster community mobilization and critical consciousness among sex workers and equip them to exercise agency in their work and personal lives.MethodsA pilot peer health education program was developed and implemented, with and for sex workers in one urban centre in Canada. To explore how the training program contributed to community empowerment and transformative learning among participants, the authors conducted qualitative interviews, asked participants to keep personal journals and to fill out feedback forms after each session. Thematic analysis was conducted on these three data sources, with emerging themes identified, organized and presented in the findings.ResultsFive themes emerged from the analysis. Our findings show that the pilot program led to reduced internalized stigma and increased self-esteem in participants. Participants’ critical consciousness increased concerning issues of diversity in cultural background, sexual orientation, work experiences and gender identity. Participants gained knowledge about how sex work stigma is enacted and perpetuated. They also became increasingly comfortable challenging negative judgments from others, including frontline service providers. Participants were encouraged to actively shape the training program, which fostered positive relationships and solidarity among them, as well as with colleagues in their social network and with the local sex worker organization housing the program. Resources were also mobilized within the sex worker community through skills building and knowledge acquisition.ConclusionThe peer education program proved successful in enhancing sex workers’ community empowerment in one urban setting by increasing their knowledge about health issues, sharing information about and building confidence in accessing services, and expanding capacity to disseminate this knowledge to others. This ‘proof of concept’ built the foundation for a long-term initiative in this setting and has promise for other jurisdictions wishing to adapt similar programs.

Interventions to address unequal gender and power relations and improve self-efficacy and empowerment for sexual and reproductive health decision-making for women living with HIV: A systematic review.

BackgroundMany women living with HIV experience gendered power inequalities, particularly in their intimate relationships, that prevent them from achieving optimal sexual and reproductive health (SRH) and exercising their rights. We assessed the effectiveness of interventions to improve self-efficacy and empowerment of women living with HIV to make SRH decisions through a systematic review.Methods and findingsWe included peer-reviewed articles indexed in PubMed, PsycINFO, CINAHL, Embase, and Scopus published through January 3, 2017, presenting multi-arm or pre-post intervention evaluations measuring one of the following outcomes: (1) self-efficacy, empowerment, or measures of SRH decision-making ability, (2) SRH behaviors (e.g., condom use, contraceptive use), or (3) SRH outcomes (e.g., sexually transmitted infections [STIs]). Twenty-one studies evaluating 11 intervention approaches met the inclusion criteria. All were conducted in the United States or sub-Saharan Africa. Two high-quality randomized controlled trials (RCTs) showed significant decreases in incident gonorrhea and chlamydia. Sixteen studies measuring condom use generally found moderate increases associated with the intervention, including in higher-quality RCTs. Findings on contraceptive use, condom self-efficacy, and other empowerment measures (e.g., sexual communication, equitable relationship power) were mixed. Studies were limited by small sample sizes, high loss to follow-up, and high reported baseline condom use.ConclusionsWhile more research is needed, the limited existing evidence suggests that these interventions may help support the SRH and rights of women living with HIV. This review particularly highlights the importance of these interventions for preventing STIs, which present a significant health burden for women living with HIV that is rarely addressed holistically. Empowerment-based interventions should be considered as part of a comprehensive package of STI and other SRH services for women living with HIV.

사회경제적 취약계층의 건강불평등 해소를 위한 지역사회 건강증진사업 평가

Objectives: This study was to evaluate effectiveness of and challenges to community interventions to reduce health inequity in socioeconomically vulnerable populations. Methods: A total of 41 participants involved in community interventions related to a slum of Seoul were recruited using purposive and snowball sampling methods from June to September, 2015. Participants included residents and stakeholders working for governments, public hospitals, welfare institutions, civil societies, and faith-based organizations. We conducted semi-structured, one-on-one interviews with 18 stakeholders and three focus group interviews with 23 residents. Qualitative data were analyzed using thematic analysis. Results: Effective community interventions were community-driven, empowerment-based interventions followed by provision of home-visiting nurses, improvement of living conditions, and integrated health-social welfare services. Affordable health care services, including home-visits by community nurses and increase in housing quality and neighborhood safety were identified as important factors to address to reduce health inequalities. Challenges to community interventions are as follows: (1) unmet healthcare and social welfare needs, (2) insufficient livelihood welfare system, (3) lack of intersectoral collaboration. Conclusions: Community-driven, empowerment-based interventions and supportive social health policies could have the potential to improve health inequities, thereby enhancing community resilience and providing a seamless safety net for the socioeconomically vulnerable populations.

Evaluation of Empowerment in Health Promotion Interventions: A Systematic Review

Although empowerment is one of the core principles of the World Health Organization's approach to health promotion, there are no standards, best practice recommendations, or guidelines for evaluating empowerment within interventions. For the development of effective empowerment promoting interventions, adequate study designs, methods, and indicators for assessing empowerment are essential. In order to better understand which evaluation procedures have been used so far, and which advantages and disadvantages are connected to them, we systematically reviewed empowerment-based health promotion interventions. We included 26 studies, which use a broad variety of quantitative, qualitative, and mixed-methods designs and various data collection methods; qualitative and mixed-methods designs predominated. The quantitative measurement instruments are heterogeneous: Mainly self-designed or modified scales are applied. All studies consider indicators reflecting individual competencies and motivations, whereas indicators capturing the organizational and political components of empowerment are less common. Involving target group members in the development of evaluation procedures and combining different data sources are mentioned as specific steps to improve the quality of data collection. Given the flexible and context-dependent nature of empowerment approaches, the development of a "gold standard" for its evaluation seems unrealistic. However, the analyzed studies can be used to deduce recommendations that may help to conduct high-quality evaluations of empowerment, for example, mixed-methods designs, participation of target groups, and reflective loops within the research team.